The Hormone Hoax Thousands Fall For

Lab tests conducted for More show that hormones custom-made to boost your well-being may do more harm than good

by Cathryn Jakobson Ramin
hormone hoax illustration
Photograph: Mark Allen Miller

To shed light on these underregulated drugmakers, More decided to test the quality of the bioidentical hormones they produce. We asked Flora Research Laboratories in Grants Pass, Oregon, which specializes in -natural-products research, to evaluate 12 prescriptions we collected from compounders throughout the U.S. Flora’s analysis revealed that these hormones are of unreliable potency and that they would not come close to meeting the FDA’s requirements for commercially manufactured drugs. Doses in the pills we tested fluctuated in a way that could increase the risk of uterine cancer because of a shortfall of the hormone progesterone. (For details of Flora’s methodology, see “How the Drugs Were Tested,” below.)

More’s testing suggests that women are wasting their money on hormone treatments that may not be effective and might put their health at risk,” concludes Bruce Bouts, MD, RPh, a Findlay, Ohio, internist who was one of the first physicians to bring compounding pharmacies to the attention of the FDA and the Ohio state pharmacy board. Notes Margery Gass, MD, executive director of the North American Menopause Society and a consultant at the Cleveland Clinic Center for Specialized Women’s Health: “The research by More indicates that women are taking a gamble when they purchase compounded estrogen and progesterone.” Why, then, are these drugs more popular than ever? Here’s what More found.

What makes bioidenticals so appealing
Prempro, a combination of conjugated equine estrogen (synthesized from pregnant mares’ urine) and a synthetic progestin called medroxyprogesterone, used to be the best-selling commercial hormone therapy; it offered an effective way to relieve much of the discomfort of menopause. But in 2002, Prempro, the only drug used in one arm of the large-scale Women’s Health Initiative (WHI), was linked with serious medical problems—such as an increased risk of heart attack, stroke, blood clots and invasive breast cancer. Faced with such alarming results, many doctors told patients who were already using hormone therapy to give it up, and they advised younger women just entering the menopausal transition to forget about HT. Sales of Prempro and similar drugs plummeted. From 2001 to 2008, the number of adult women filling one or more commercial HT prescriptions annually fell, from 17.9 million to 5.8 million, a decrease of 68 percent.

Perimenopausal and postmenopausal women still experienced disruptive symptoms and still needed relief. Consequently, in 2002, bio-identical hormones, marketed as safer than commercial HT products because they were more natural, started to take off.

Bioidentical estrogen and progesterone are made from diosgenin, a plant-derived sterol found in wild yams, and are identical in molecular structure to hormones produced in a woman’s body. Bioidentical estrogen is believed to fit into the body’s estrogen receptors perfectly, without causing the bio-chemical disturbance sometimes created by the conjugated equine estrogen used in commercially formulated HT, which is a less perfect molecular match. A similar situation exists with bioidentical progesterone. However, researchers have not published a head-to-head comparison of bioidenticals and conventional HT in terms of risks for stroke, cancer and other illnesses. At this point, the safety advantages of BHT are only hypothetical.

Nor is it accurate to say that compounded bioidenticals are more natural than those in FDA-approved commercial HT formulations; both are heavily synthesized products. You can’t simply pluck a yam from the dirt, cut it open and rub it on your skin; the manufacture of bioidenticals involves multiple levels of processing in a sophisticated laboratory. A better name for such products would be bio-available hormones (since the sterol is available in plants), or plant-​derived sterol hormones. But the term bio-identical has the appeal of sounding completely safe, so it stuck.

First published in the October 2013 issue

Share Your Thoughts!


Karen 02.28.2015

It's perfectly reasonable to be skeptical of "alternatives," but I would've preferred to see just as much skepticism of the "traditional" approaches, which have, in large part, gotten plenty wrong. It's not like the FDA, the pharmaceutical industry, and their audience-doctors are exactly without flaws. It's not like it is only the alternative doctors who are in it "for the money" as this article implies. In fact, many of the theories and approaches of the bioidentical hormone movement that were heavily criticized years ago, are now being adopted by the pharmaceutical industry, who have more of the money to prove their worth through convenient testing. Now, thanks in large part to the alternative movement, hormone replacement therapy, once deemed "dangerous" is now considered "beneficial," even for BRCA patients. I also would've preferred that More quoted not just Somers' books, but more of the BHT doctors. I would've loved to hear their defense. This article was chock-full of quotes and interviews from, basically, just the opponents.

Arros 12.18.2013

Working for Wyeth are we?
You write as if you took only the worse-case scenarios, stretch the "fear factor" and sensationalize anything about compounding and put an article together to sell advertisements. Good for you for putting your bottom dollar first and not explore more into what BHRT has done for hundreds of thousands of women who get tens of thousands of different customized medications.
Also, the Estriol fiasco was debunked a long time ago when Wyeth themselves marketed Estriol in Europe as a "wonder drug". I guess I'll be looking at MORE LESS!!!!


As a woman who has tried both bioidentical and FDA approved HRT I am shocked by the misleading and quite frankly, slanderous spin of this article. I could write a novel about the years I tried to help my body get through menopause with chemical "equivalents". I could write another novel about how a Naturopathic physician who prescribed compounded BHRT (in cream form, which is better absorbed than pill form) helped me feel like a vibrant woman again, not some nut job bouncing off walls, growing facial hair and a penis from the one-size-fits-all FDA approved horse urine therapy. But I will simply say this, your story is blatantly irresponsible and will only serve to get more women interested in drugs, which will help the FDA to achieve its goal of tapping into that $2.5 billion dollar biodentical "industry". The government needs to get its hands off of my body and moreover, my constitutional right to choose what I put into it. Thank you very much, I'll pick yams over pregnant horse urine every time.

Post new comment

Click to add a comment